窄带光成像联合超声内镜在壶腹部肿瘤诊断中的应用价值  

Diagnostic value of narrow-band imaging combined with endoscopic ultrasonography for ampullary tumors

作　　者：唐硕 覃山羽[1] 姜海行[1] 罗薇[1] 卢东红[1] 陶霖[1] 宁红建[1] 苏思标[1] Tang Shuo;Qin Shanyu;Jiang Haixing;Luo Wei;Lu Donghong;Tao Lin;Ning Hongjian;Su Sibiao(Department of Gastroeriterology, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China)

机构地区：[1]广西医科大学第一附属医院消化内科,南宁530021

出　　处：《中华消化内镜杂志》2019年第2期108-112,共5页Chinese Journal of Digestive Endoscopy

基　　金：国家自然科学基金(31360221);广西教育厅桂教科研(LX2014076);广西卫生厅自筹课题(Z2016322);广西医疗卫生适宜技术开发与推广应用项目(S2017024).

摘　　要：目的探讨窄带光成像联合超声内镜检查术(EUS)用于壶腹部肿瘤的诊断价值。方法2015年12月至2017年3月,21例影像学或内镜检查怀疑壶腹部病变的患者纳入前瞻性研究,入组患者均行窄带光成像和EUS,其中20例患者还进行了活检,根据术前检查预测壶腹部肿瘤性质并选择合适的治疗方式。结合活检、手术病理及临床6个月以上随访明确最终诊断,并以此为金标准计算窄带光成像联合EUS、活检方法诊断壶腹部恶性肿瘤的准确性指标值,诊断准确率两种方法间比较行卡方检验。结果窄带光成像联合EUS诊断壶腹部恶性肿瘤的灵敏度为94.1%(16/17),特异度为100.0%(4/4),准确率为95.2%(20/21),阳性预测值为100.0%(16/16),阴性预测值为80.0%(4/5)。术前活检诊断壶腹部恶性肿瘤的灵敏度为41.2%(7/17),特异度为100.0%(3/3),准确率为50.0%(10/20),阳性预测值为100.0%(7/7),阴性预测值为23.1%(3/13)。窄带光成像联合EUS诊断壶腹部恶性肿瘤的准确率明显高于术前活检,差异有统计学意义(P=0.004)。结论窄带光成像联合EUS可以较准确地预测壶腹部肿瘤的良恶性,较术前活检有明显优势,可以更好地指导手术方式的选择。ObjectiveTo study the diagnostic value of narrow-band imaging (NBI) combined with endoscopic ultrasonography (EUS) for ampullary tumors. MethodsA total of 21 patients suspected with ampullary lesions by imaging or endoscopic examination from December 2015 to March 2017 were enrolled in this prospective study. All patients underwent NBI and EUS, and 20 patients underwent biopsy. The type of ampullary tumor was predicted by preoperative examination, and appropriate treatment methods were chosen. The final diagnosis was confirmed by biopsy, surgical pathology, and clinical follow-up for more than 6 months. The accuracy of NBI combined with EUS and biopsy in diagnosis of ampullary malignant tumors was calculated according to the gold standard. The Chi-square test was used to compare diagnostic accuracies. ResultsThe sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of NBI combined with EUS in diagnosis of ampullary malignancies were 94.1%(16/17), 100.0%(4/4), 95.2%(20/21), 100.0%(16/16), and 80.0%(4/5), respectively. The corresponding indicators of preoperative biopsy were 41.2%(7/17), 100.0%(3/3), 50.0%(10/20), 100.0%(7/7), and 23.1%(3/13), respectively. The accuracy of NBI combined with EUS in diagnosing ampullary malignant tumor was significantly higher compared with preoperative biopsy (P=0.004). ConclusionNBI combined with EUS can more accurately predict benign or malignant ampullary tumor, and better guide the choice of surgical methods compared with preoperative biopsy.

关 键 词：诊断技术 消化系统 超声检查 窄带光成像 术前活检 壶腹部肿瘤 

分 类 号：R735.0[医药卫生—肿瘤]